Progress to date on diagnostic therapeutic and preventative strategies, for endometriosis has been slow. The Adelaide Endometriosis Group has several project designed to benefit women with endometriosis.
We hypothesised that endometriosis associated plasma microRNAs may be biomarkers with diagnostic potential. To test this hypothesis, microRNA array analyses on the plasma from 8 women with and without endometriosis. Twelve plasma microRNAs were significantly differentially regulated in women with endometriosis (FC>1.5, p<0.01), of which 3 passed the correction for multiple testing. To develop a non-invasive diagnostic test, algorythms based on data from a further 68 samples are being developed, before validation in a test set of 118 plasma samples.
As TGFB1 has a central role in endometriotic tissues, we proposed that its absence could inhibit endometriosis and provide a therapeutic benefit for women. Smaller lesions were seen when human endometrial tissue was xenografted into TGFB1 knockout mice compared to wild type controls. TGFB1 Knockout lesions demonstrated a 31% reduction in glandular volume fraction and reduced numbers of macrophages and myofibroblasts. Host derived TGFB1 deficiency may suppress ectopic endometrial lesion development by reducing macrophage and myofibroblast mediated glandular remodelling. Clinical manipulation of TGFB1 may thus have a therapeutic benefit for women with endometriosis.
As seminal plasma contains high levels of TGFB1, perimenstrual seminal fluid exposure may enhance the development of endometriotic lesions. In this scenario, perimentrual abstinence or condom use may be a preventative strategy for endometriosis. Human endometrial tissue was exposed to seminal plasma in vitro and/or in vivo in a SCID mouse model of endometriosis. Larger lesions were identified after In vitro but not in vivo exposure of endometrium to seminal fluid. It may be that simple behavioural changes effect a reduction in risk of endometriosis for some women.
These examples demonstrate that new diagnostic, therapeutic and preventative strategies are being developed as our knowledge of endometriosis improves. The future promises to broaden our approach to the clinical management of endometriosis.